Tuesday, August 03, 2010

CityWatchLA - Distracting from Bigger Issues

LA's City Council is poised to approve two contracts that will allow the LA Fire Department to outsource the Emergency Medical Services Billing and Collection System (EMSS) while implementing the Fire Department Field Data Capture System (FDCS). This will allow the LAFD to manage patient history data, communicate emergency information and initiate billing data collection on scene.

The anticipated approval of these contracts will mark the end of a journey that began eight years ago, addressing the issue of uncollected debts that was highlighted by the City Controller and the City Council during the recent budget debates.

While the $10 million contract with Scanhealth for a digital data transfer system promises to improve the delivery of services using digital data transfer, it is the contract with Advanced Data Processing Inc. that is positioned as an opportunity to improve billing collections and contribute to the City's General Fund.

In the 2009 fiscal year, the LAFD billed $151 million for emergency medical services but collected only $58 million. The outsourcing of the billing and the increase in ambulance fees are both positioned by the Mayor and the Controller as important steps that will allow the LA to deliver on the LAFD's mission while efficiently recovering the costs of the service. In addition, the proposal is designed to protect the City from exposure to Federal, State and HIPAA liability.

While there is some controversy over these proposals … unions want city workers trained to do the work and there is the charge that it constitutes double billing, once when the taxpayers fund the LAFD and again when they pay for the services as rendered … but by the end of Tuesday, it's expected that the contracts will be approved, the vendors will go to work on implementation, and the LAFD will continue providing world class service to the people of Los Angeles.

As for the Mayor and the City Council, now is the time for them to initiate a larger discussion on the issues that have been overshadowed by the current emphasis on increasing the LAFD's General Fund contribution through an improved data and billing collection process.

1) The Los Angeles Fire Department's PIO, Brian Humphreys refers to the LAFD as "The tip of the spear for an ailing health care system, providing primary medical care to a sizable portion of LA's population."

Statistically, it seems simple, increase the collection rate and increase contribution to the General Fund. But another way to approach this is to ask "Who is calling the LAFD and why are they going to the LAFD for primary health care?"

People with no money or with no connection to medical services are hardly in a position to respond to a more efficient billing process. They're symptoms of a larger broken system.

2) The Los Angeles Fire Department is a Social Services agency in communities such as Hollywood, addressing the mental, substance abuse, social, and medical needs of the homeless population.

One of Hollywood's LAFD Captains estimated that as much as 40% of their resources was dedicated to the task. An increase in the efficiency of the billing process will not address the fact that the LAFD has become the de facto caretaker of LA's invisible population.

3) The Los Angeles Fire Department spends an inordinate amount of time responding to traffic collisions, responding to approximately 100 per day and taking responsibility for emergency medical services as well as transportation of victims.

By contrast, the County Fire Department also responds but then relies on private ambulances to transport victims.

Increasing the efficiency of the billing process doesn't address the fact that the service itself might be better privatized in the case of traffic collisions and that unlicensed and/or uninsured motorists are not likely to respond to a more efficient billing process.

The City Council's pursuit of efficiencies in data management and in billing collections are commendable but these motions fail to address the larger issue of causality and of responsibility.

Whether it's the poor without health insurance or the means to pay for an ambulance, motorists or passengers without auto insurance, or indigent without MediCal/Medicare coverage, the fact remains that the City is quickly ending a conversation that should be taking place with the County, the State, and the Federal providers of medical services and support.

The Los Angeles Fire Department is a world class organization and offers everything from emergency medical care to the supervision of movie set pyrotechnic stunts.

The LAFD is also a leader in the training of community members for emergency preparedness in the Community Emergency Response Teams and Urban Search & Rescue Teams, an investment for the times that the LAFD needs support.

This ongoing work has resulted in a citywide full service Life Safety Network, a system that has proven its value during incidents such as the Griffith Park fire, the Station fire, and the Metrolink Train crash.

The first opportunity here is to move beyond simple data and billing collection and to fully support the LAFD by looking for systemic solutions that address homelessness, traffic collisions, and patients who lack medical services and support, all of whom currently rely on the LAFD for high quality and unconditional medical services and transport.

While the idea of reducing homelessness, traffic collisions and poverty may seem unrealistic, the opportunity for City Family efficiencies in the delivery of services is certainly worth exploring, not ignoring.

The second opportunity here is for the Mayor and the City Council to look beyond the LAFD as a simple General Fund contributor and to rally the city departments who are responsible for traffic safety on the streets, for social services, for connecting Angelenos with the County, State and Fed medical services, and for Emergency Preparedness and to work together to make sure that Los Angeles is pursuing maximum outside funding for the great work that the LAFD does.

(Stephen Box is a grassroots advocate and writes for CityWatch. He can be reached at Stephen@thirdeyecreative.net. Disclosure: Box is also a candidate for 4th District Councilman.)